Objective:To explore the guiding role of blood concentration monitoring (TDM) for valproate (VPA) in the treatment of epilepsy,and provide reference for the clinical rational use. Methods:Totally 384 epilepsy patients treated with VPA alone were collected between August 2016 and November 2017 in our hospital. The serum concentrations of VPA were determined by HPLC. The relationship was analyzed between TDM and the efficacy and safety. The correlation between TDM and factors(age, dose,sex and dosage form)was assessed using binary logistic regression. Results:Among the 384 patients,272 (70.83%) ones were with an effective range of blood (50-100 μg·ml-1). The clinical efficacy within the range of effective blood concentration (50-100 μg·ml-1) and that with the plasma concentration above 100 μg·ml-1were both significantly higher than that with the plasma concentration below 50 μg·ml-1(P < 0.01). The incidence of adverse reactions with the range above 100 μg·ml-1was significantly higher than that with the range below 50 μg·ml-1and within the range of 50-100 μg·ml-1. Logistic regression analysis showed that dose and age had significant effect on the blood concentration(P < 0.05). Conclusion:The individual difference of VPA is obvious,therefore,VPA should be used in clinic based on TDM to improve the clinical effect and reduce the adverse reactions.

Objective:To systematically evaluate the effect of umbilical therapy in adult ulcerative colitis.Methods:The clinical randomized controlled trials (RCT) related to the effect of umbilical therapy in ulcerative colitis in the Chinese and English databases were systematically searched, and their citations were traced. The search time limit was from the establishment of each database to December 30, 2020. Two researchers screened and evaluated the articles according to the inclusion and exclusion criteria, and extracted article information and data. RevMan5.3 was used for meta-analysis.Results:A total of 13 Chinese articles were included, with 898 patients. The results of meta-analysis showed that there was no statistically significant difference in the general symptom relief rate [ RR=0.70, 95% CI (0.12, 4.19), P=0.70]and effective rate [ RR=0.93, 95% CI (0.54, 1.59), P=0.86]between conventional therapy and umbilical therapy alone. Umbilical therapy combined with conventional therapy can improve the effective rate of treatment [ RR=1.26, 95% CI (1.18, 1.35), P<0.000 01], general symptom relief rate [ RR=1.94, 95% CI (1.44, 2.61), P<0.000 1], abdominal pain relief rate [ RR=1.90, 95% CI (1.42, 2.54), P<0.000 1], diarrhea relief rate [ RR=1.32, 95% CI (1.07, 1.64), P=0.01], remission rate of pus and blood stool [ RR=1.22, 95% CI (1.03, 1.44), P=0.02]and reduced disease activity [ MD=-1.79, 95% CI (-3.37, -0.21), P=0.03]. In terms of adverse reactions, the difference between the two groups was not statistically significant [ RR=0.33, 95% CI (0.08, 0.80), P=0.13]. Conclusions:The efficacy of umbilical therapy alone is equivalent to that of conventional therapy, but umbilical therapy combined with conventional therapy is more effective in improving the treatment effective rate, general symptom relief rate and clinical symptoms. Due to the limitation of the number and quality of the included studies, long-term follow-up, large sample and rigorous RCT studies are needed to prove it.